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Introduction
A complete ilio-inguinal groin lymphadenectomy (CLND) is the golden standard for stage III melanoma patients. However, the CLND is associated with many postoperative complications; such as infection, seroma, dehiscence and necrosis. Some studies show that the postoperative complications rate can rise to 77%. To reduce the percentage of postoperative complications many studies have tried to make alterations in the CLND procedure. Unfortunately, this did not lead to a decline in complications. Therefore, an alternative was proposed; the minimal invasive videoscopic inguinal lymphadenectomy (V-ILF). The first studies are promising; they show a decline in postoperative complications after V-ILF. The aim of this study was to determine the short- and long term complications after V-ILF.
Methods
Melanoma patients with lymph node metastasis located at the groin underwent a V-ILF at the University Medical Centre Groningen (UMCG). Most of these patients also underwent an iliac lymphadenectomy by an open procedure. The V-ILF patients were prospectively included between November 2015 and April 2017. These patients were compared with a historic cohort of CLND patients at the UMCG. The primary outcome was the number and severity of postoperative complications (graded by the Clavien Dindo classification) following V-ILF. The secondary outcome measures were the degree of lymphedema 3 months postoperatively and the postoperative functional restrictions after a V-ILF. Continuous variables were analysed with a T-test, not normally distributed continuous variables and ordinal variables with a Mann - Whitney U test and binominal variables with a Chi square or Fisher ‘s exact.
Results
Fourteen patients underwent a V-ILF of which two patients (14%) were man and 12 patients (86%) were women. Twelve of the 14 patients also underwent an iliac lymphadenectomy by an open procedure. The CLND was performed on 23 patients of which 10 patients (43%) were man and 13 patients (57%) were women. After the V-ILF there were seven wound complications (54%) versus 17 wound complications (65%) after a CLND. The number and severity of the complications after the V-ILF were not significantly less than after the CLND. However, there were no operative re-interventions necessary after the V-ILF in contrast to the CLND group where 38% of the complications required an operative re-intervention. This was significantly different. Following the V-ILF 29% of patients had slight lymphedema. Thirty percent of the CLND patients had lymphedema; which was either slight or moderate. The difference in degree of lymphedema was not significant. Finally, no patient had a reduced range of motion after the V-ILF versus three patients after the CLND, the difference was not significant.
Conclusion
The V-ILF is a promising alternative for the CLND. The results show a significant reduction in operative re-interventions after a V-ILF. There were no significant differences between the V-ILF and CLND in the number and severity of postoperative complications or the secondary outcome measures.